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Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19.
Hardenberg, Jan-Hendrik B; Stockmann, Helena; Aigner, Annette; Gotthardt, Inka; Enghard, Philipp; Hinze, Christian; Balzer, Felix; Schmidt, Danilo; Zickler, Daniel; Kruse, Jan; Körner, Roland; Stegemann, Miriam; Schneider, Thomas; Schumann, Michael; Müller-Redetzky, Holger; Angermair, Stefan; Budde, Klemens; Weber-Carstens, Steffen; Witzenrath, Martin; Treskatsch, Sascha; Siegmund, Britta; Spies, Claudia; Suttorp, Norbert; Rauch, Geraldine; Eckardt, Kai-Uwe; Schmidt-Ott, Kai M.
  • Hardenberg JB; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Stockmann H; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Aigner A; Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Gotthardt I; Berlin Institute of Health (BIH), Berlin, Germany.
  • Enghard P; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Hinze C; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Balzer F; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Schmidt D; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Zickler D; Division IT, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Kruse J; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Körner R; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Stegemann M; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Schneider T; Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Schumann M; Department of Gastroenterology, Infectiology and Rheumatology (CBF), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Müller-Redetzky H; Department of Gastroenterology, Infectiology and Rheumatology (CBF), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Angermair S; Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Budde K; Department of Anesthesiology and Operative Intensive Care Medicine (CBF), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Weber-Carstens S; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Witzenrath M; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Treskatsch S; Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Siegmund B; Department of Anesthesiology and Operative Intensive Care Medicine (CBF), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Spies C; Department of Gastroenterology, Infectiology and Rheumatology (CBF), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Suttorp N; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Rauch G; Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Eckardt KU; Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Schmidt-Ott KM; Berlin Institute of Health (BIH), Berlin, Germany.
Kidney Int Rep ; 6(4): 905-915, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1169160
Semantic information from SemMedBD (by NLM)
1. COVID-19 PREDISPOSES Kidney Failur
Subject
COVID-19
Predicate
PREDISPOSES
Object
Kidney Failur
2. Kidney Failur PROCESS_OF C0030705
Subject
Kidney Failur
Predicate
PROCESS_OF
Object
C0030705
3. Complication COEXISTS_WITH COVID-19
Subject
Complication
Predicate
COEXISTS_WITH
Object
COVID-19
4. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
5. Comorbidity PROCESS_OF Patients
Subject
Comorbidity
Predicate
PROCESS_OF
Object
Patients
6. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
7. Vasopressor therapy PREDISPOSES Kidney Failur
Subject
Vasopressor therapy
Predicate
PREDISPOSES
Object
Kidney Failur
8. Kidney Failur COEXISTS_WITH C5203670
Subject
Kidney Failur
Predicate
COEXISTS_WITH
Object
C5203670
9. Kidney Failur COEXISTS_WITH C0010340
Subject
Kidney Failur
Predicate
COEXISTS_WITH
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C0010340
10. Kidney Failur COEXISTS_WITH C0021368
Subject
Kidney Failur
Predicate
COEXISTS_WITH
Object
C0021368
11. Procedure findings:Finding:Point in time:^Patient:Narrative PREDISPOSES Kidney Failur
Subject
Procedure findings:Finding:Point in time:^Patient:Narrative
Predicate
PREDISPOSES
Object
Kidney Failur
12. COVID-19 PREDISPOSES Kidney Failure, Acute
Subject
COVID-19
Predicate
PREDISPOSES
Object
Kidney Failure, Acute
13. Kidney Failure, Acute PROCESS_OF Patients
Subject
Kidney Failure, Acute
Predicate
PROCESS_OF
Object
Patients
14. Complication COEXISTS_WITH COVID-19
Subject
Complication
Predicate
COEXISTS_WITH
Object
COVID-19
15. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
16. Comorbidity PROCESS_OF Patients
Subject
Comorbidity
Predicate
PROCESS_OF
Object
Patients
17. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
18. Vasopressor therapy PREDISPOSES Kidney Failure, Acute
Subject
Vasopressor therapy
Predicate
PREDISPOSES
Object
Kidney Failure, Acute
19. Kidney Failure, Acute COEXISTS_WITH COVID-19
Subject
Kidney Failure, Acute
Predicate
COEXISTS_WITH
Object
COVID-19
20. Kidney Failure, Acute COEXISTS_WITH Critical Illness
Subject
Kidney Failure, Acute
Predicate
COEXISTS_WITH
Object
Critical Illness
21. Kidney Failure, Acute COEXISTS_WITH Inflammation
Subject
Kidney Failure, Acute
Predicate
COEXISTS_WITH
Object
Inflammation
22. Procedure findings:Finding:Point in time:^Patient:Narrative PREDISPOSES Kidney Failure, Acute
Subject
Procedure findings:Finding:Point in time:^Patient:Narrative
Predicate
PREDISPOSES
Object
Kidney Failure, Acute
ABSTRACT

INTRODUCTION:

Acute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development.

METHODS:

We performed an observational cohort study of 223 consecutive COVID-19 patients treated at 3 sites of a tertiary care referral center to describe the evolvement of severe AKI (Kidney Disease Improving Global Outcomes stage 3) and identify conditions promoting its development. Descriptive statistics and explanatory multivariable Cox regression modeling with clinical parameters as time-varying covariates were used to identify risk factors of severe AKI.

RESULTS:

Severe AKI developed in 70 of 223 patients (31%) with COVID-19, of which 95.7% required kidney replacement therapy. Patients with severe AKI were older, predominantly male, had more comorbidities, and displayed excess mortality. Severe AKI occurred exclusively in intensive care unit patients, and 97.3% of the patients developing severe AKI had respiratory failure. Mechanical ventilation, vasopressor therapy, and inflammatory markers (serum procalcitonin levels and leucocyte count) were independent time-varying risk factors of severe AKI. Increasing inflammatory markers displayed a close temporal association with the development of severe AKI. Sensitivity analysis on risk factors of AKI stage 2 and 3 combined confirmed these findings.

CONCLUSION:

Severe AKI in COVID-19 was tightly coupled with critical illness and systemic inflammation and was not observed in milder disease courses. These findings suggest that traditional systemic AKI mechanisms rather than kidney-specific processes contribute to severe AKI in COVID-19.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Kidney Int Rep Year: 2021 Document Type: Article Affiliation country: J.ekir.2021.01.011

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Kidney Int Rep Year: 2021 Document Type: Article Affiliation country: J.ekir.2021.01.011